It may not be a hot topic of conversation at dinner parties, but constipation—both acute and chronic—is a serious health issue. Modern diets and lifestyles often contribute to the condition, leaving millions of Americans stuck with the problem on a regular basis.

In treating constipation, experts generally recommend making dietary changes first. If this doesn't defeat the problem, other remedies may be needed. These remedies range from bulking agents such as psyllium to stronger stimulant laxatives, including cascara sagrada and senna. Finally, there is a wide range of homeopathic medicines, both combination remedies and single remedies, that can be helpful to sufferers of constipation.

Leandra Even, N.D., a Las Vegas, Nev.-based naturopath and advanced practitioner of homeopathy, says that diet and lifestyle are the main culprits in causing constipation. "How many of us are office workers who sit for hours and hours each day?" she asks. "We're not meant for this 12-hour sitting thing."

Not only do jobs cause stress, but busy schedules may require that people wait until the end of the day to defecate. "When you're not able to naturally respond to the desire to defecate, suppression causes the body to become untrained," Even says. And sedentary lifestyles can cause the musculature surrounding the intestinal system to grow lazy, exacerbating the problem. Even recommends physical activity such as yoga and abdominal massage as one way to help tone the intestinal muscle system.

But often dietary changes are needed too. First, certain foods may need to be cut from the diet. "Wheat is probably the No. 1 causative factor, followed by dairy, especially cheese," Even says.

Next, it's important to add fiber to the diet, whether in food form or as a supplement. "Inadequate fiber is of course a primary cause of constipation. Fiber has an extensive history of use," says Even. Psyllium husks, apple pectin and chitosan are common supplemental fibers, but Even favors ground flaxseed, because it also has estrogen-conversion properties that are especially useful for women suffering from premenstrual constipation.

"Good fiber will promote the growth of good organisms [in the intestine] and pull out those that are not beneficial," Even says. "Of course, plain old simple probiotics help too. Acidophilus is my favorite. If the intestinal flora isn't correct, that can cause constipation."

Sometimes, though, even supplemental fiber and other dietary changes aren't enough to get things moving. In such cases, stronger remedies are required, and that's where stimulant laxatives come in. "I try to start with something very gentle first," Even says. "Chamomile and dandelion root both have nice bitter effects and gently promote stimulus of the bowels and bile production. Bile itself is a natural stimulus and a significant contributing factor.

"The next step is Fumaria officinalis, which has similar effects [to chamomile and dandelion root] but is stronger and more dynamic," Even says. And if these don't do the trick? "The end stage is cascara sagrada, but the big concern is that we don't want to create an addictive situation where the bowels get reliant on stimulus." For this reason, Even never recommends using cascara sagrada or senna—another strong laxative—for more than 30 consecutive days.

Dana Ullman, M.P.H., is a Berkeley-Calif.-based homeopathic practitioner and author of eight books, including Essential Homeopathy (New World Library, 2002). He also cautions against prolonged use of stimulant laxatives. "Here's a critique of some of the herbal remedies," he says. "The occasional use of any type isn't a problem, but more frequent use is, because a basic premise in natural healing is that whenever you get something done for you, you don't learn to do it yourself—both physiologically and psychologically. What homeopathy offers is a different approach to strengthening the body so it can perform various functions in a healthy manner."

Homeopathy's approach depends on whether the problem is acute or chronic. If chronic, Ullman recommends a visit to a homeopathic practitioner who can provide specific recommendations. For acute constipation, Ullman suggests trying one of the many combination or formula products. "This is basically a shotgun approach using some of the more common homeopathic remedies for symptoms of constipation," he says.

There is also a variety of herbal combination remedies on the market. Scott Smith, vice president of corporate development for Castle Rock, Colo.-based Natural Balance, says its natural laxative has been on the market for nearly 14 years and continues to be a top seller because it's gentle but dependable. Rather than relying on a single herb, the product contains a blend that includes cascara sagrada, senna, rhubarb and black walnut.

Smith says that such products can be helpful when used in conjunction with bulking agents such as psyllium. "Some bulking formulas that include psyllium can cause bloating and slowing, so Colon Clenz can help move things through and enhance the action of fiber-based bulking products," he says.

Though retailers have many options to recommend to shoppers searching for constipation relief, it's important to remember that chronic constipation can be indicative of a more serious health problem. "If there is extreme, consistent constipation, that's an indicator that something more serious may be happening," Even says. "A more serious condition may also be indicated by the presence of other signs and symptoms, including rectal bleeding, abdominal pain, alternating diarrhea and constipation, changes in the color of stools, and a family history of colitis or colon cancer."

Smith shares a story that seconds this notion: "One of our sales reps was in a store in Philadelphia, and a woman came in who weighed 400 pounds and hadn't had a bowel movement in two weeks. She needed to go to the emergency room for medical treatment. Retailers should be aware that in some cases standard medical treatment might be the most appropriate course of action."

Natural Foods Merchandiser volume XXIII/number 1/p. 32, 37

Natural Foods Merchandiser volume XXIII/number 1/p. 37